School of Psychological Science, La Trobe University, Melbourne, VIC 3086, Australia.
Schizophr Res. 2012 Sep;140(1-3):17-24. doi: 10.1016/j.schres.2012.06.022. Epub 2012 Jul 10.
Suicide-related behaviors (suicide attempts and suicides) are common in the early phase of psychotic disorders. Studies have examined risk factors among baseline and historical (i.e., past) variables, yet little is known about recent characteristics that increase suicide risk during treatment for first-episode psychosis (FEP). This study had two aims: first, to determine the relative importance of baseline, past, and recent variables to the prediction of suicide-related behaviors in patients with FEP; second, to identify recent characteristics that exert most influence on suicide risk levels and which could become foci of preventive interventions.
This was a case-control study of 180 patients from a cohort entering a specialist FEP service between 1/12/2002 and 30/11/2005. Data for 72 cases and 108 matched controls were obtained via medical record audit. Multivariate logistic regression models assessed the contribution of baseline, past, and recent domains. Suicide attempt or suicide during treatment was the outcome variable.
The strongest risk factors for suicide-related behaviors were: baseline depressive symptoms, baseline suicidal ideation/intent, past negative events, past non-suicidal self-injurious behavior, recent negative events, recent depressive symptoms, and recent non-suicidal self-injurious behavior. However, when these were entered into a hierarchical logistic regression model, only recent non-suicidal self-injurious behavior (AOR=72.96, p<0.001), and recent negative events (AOR=1.90, p=0.003) remained significant predictors. The final model accurately classified 75.5% of cases and 89.2% of controls, and explained 72.0% of variance in the suicide attempt status.
Since recent negative events and recent non-suicidal self-injurious behavior were the strongest predictors of suicide-related behaviors during treatment for FEP, psychiatric services could consider incorporating psychosocial interventions addressing affect regulation, interpersonal effectiveness, stress management and problem solving, alongside case management and pharmacotherapy, to help to reduce the rates of suicide attempts and suicides in first-episode patients.
自杀相关行为（自杀未遂和自杀）在精神病早期阶段很常见。研究已经检查了基线和历史（即过去）变量中的危险因素，但对于首发精神病（FEP）治疗期间增加自杀风险的近期特征知之甚少。本研究有两个目的：首先，确定基线、过去和近期变量对 FEP 患者自杀相关行为预测的相对重要性；其次，确定对自杀风险水平影响最大的近期特征，这些特征可能成为预防干预的重点。
这是一项病例对照研究，纳入了 2002 年 12 月 1 日至 2005 年 11 月 30 日期间进入专科 FEP 服务的 180 名患者。通过病历审核获得了 72 例病例和 108 例匹配对照的数据。多变量逻辑回归模型评估了基线、过去和近期领域的贡献。治疗期间的自杀未遂或自杀是结局变量。
自杀相关行为的最强危险因素是：基线时的抑郁症状、基线时的自杀意念/意图、过去的负面事件、过去的非自杀性自伤行为、近期的负面事件、近期的抑郁症状和近期的非自杀性自伤行为。然而，当这些因素被纳入分层逻辑回归模型时，只有近期的非自杀性自伤行为（OR=72.96，p<0.001）和近期的负面事件（OR=1.90，p=0.003）仍然是显著的预测因素。最终模型准确地分类了 75.5%的病例和 89.2%的对照，解释了自杀未遂状态 72.0%的方差。
由于近期的负面事件和近期的非自杀性自伤行为是 FEP 治疗期间自杀相关行为的最强预测因素，精神科服务可以考虑纳入心理社会干预措施，解决情绪调节、人际有效性、压力管理和解决问题，以及病例管理和药物治疗，以帮助降低首发患者的自杀未遂和自杀率。
